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Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study

BACKGROUND: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer pati...

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Autores principales: Kang, Ji-Yeon, Kim, Sang-Yup, Lim, Jae-Seok, Kim, Jwa-Young, Jin, Ga-Youn, Lee, Yeon-Jung, Lee, Eun-Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Nature Singapore 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313599/
https://www.ncbi.nlm.nih.gov/pubmed/37389685
http://dx.doi.org/10.1186/s40902-023-00391-9
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author Kang, Ji-Yeon
Kim, Sang-Yup
Lim, Jae-Seok
Kim, Jwa-Young
Jin, Ga-Youn
Lee, Yeon-Jung
Lee, Eun-Young
author_facet Kang, Ji-Yeon
Kim, Sang-Yup
Lim, Jae-Seok
Kim, Jwa-Young
Jin, Ga-Youn
Lee, Yeon-Jung
Lee, Eun-Young
author_sort Kang, Ji-Yeon
collection PubMed
description BACKGROUND: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231–236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva®, 120mg). CASE PRESENTATION: In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for metastatic cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site. Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period. CONCLUSION: Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effective in managing the condition. Additional studies are needed to investigate the contribution of steroids and anticancer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB.
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spelling pubmed-103135992023-07-02 Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study Kang, Ji-Yeon Kim, Sang-Yup Lim, Jae-Seok Kim, Jwa-Young Jin, Ga-Youn Lee, Yeon-Jung Lee, Eun-Young Maxillofac Plast Reconstr Surg Case Report BACKGROUND: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231–236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva®, 120mg). CASE PRESENTATION: In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for metastatic cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site. Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period. CONCLUSION: Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effective in managing the condition. Additional studies are needed to investigate the contribution of steroids and anticancer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB. Springer Nature Singapore 2023-06-30 /pmc/articles/PMC10313599/ /pubmed/37389685 http://dx.doi.org/10.1186/s40902-023-00391-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Report
Kang, Ji-Yeon
Kim, Sang-Yup
Lim, Jae-Seok
Kim, Jwa-Young
Jin, Ga-Youn
Lee, Yeon-Jung
Lee, Eun-Young
Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title_full Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title_fullStr Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title_full_unstemmed Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title_short Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
title_sort denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313599/
https://www.ncbi.nlm.nih.gov/pubmed/37389685
http://dx.doi.org/10.1186/s40902-023-00391-9
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